Cave canem (beware of the dog): severe complications following a bite by a small dog

Pre-school children are at highest risk for dog bites. A 2-year-old boy was bitten by a little Pinscher nano dog causing deep injuries which were not apparent on first evaluation. A few hours later he had severe respiratory failure, consistent with subglottic injury. Marked neck enlargement was caused by widespread subcutaneous emphysema. The airway oedema and superimposed systemic infection required a week of intensive care to improve and restore spontaneous breathing. Even an apparently benign bite lesion can evolve into a life-threatening respiratory condition, and there should be a high index of suspicion for every neck lesion in a child.